{"id":10208,"date":"2011-10-14T08:00:47","date_gmt":"2011-10-14T12:00:47","guid":{"rendered":"http:\/\/pmedicine.org\/epatients\/?p=10208"},"modified":"2021-09-27T12:47:56","modified_gmt":"2021-09-27T16:47:56","slug":"the-patient-activation-measure-pam-a-framework-for-developing-patient-engagement","status":"publish","type":"post","link":"https:\/\/participatorymedicine.org\/epatients\/2011\/10\/the-patient-activation-measure-pam-a-framework-for-developing-patient-engagement.html","title":{"rendered":"The Patient Activation Measure (PAM): a framework for developing patient engagement"},"content":{"rendered":"

In any movement there’s a stage of maturation, where aspirations get fleshed out with specifics. That time is arriving for participatory medicine.<\/p>\n

As patient engagement (aka consumer engagement) \u00a0earns attention, the question increasingly arises: “Where do we start? What can we do?” More specifically, “What do we mean<\/em> when we say ‘patient engagement’?”<\/p>\n

CFAH Engagement Behavior Framework<\/strong><\/p>\n

For me, the first big conceptual breakthrough was in May, when Jessie Gruman’s Center for Advancing Health published its Engagement Behavior Framework, as we reported here<\/a>. (See PDFs at bottom of that post.) Her team methodically identified 43 behaviors – 43 ways every patient or their proxy will sooner or later engage with the system. They grouped them into ten categories:<\/p>\n

    \n
  1. Find Safe, Decent Care<\/li>\n
  2. Communicate with Health Care Professionals<\/li>\n
  3. Organize Health Care<\/li>\n
  4. Pay for Health Care<\/li>\n
  5. Make Good Treatment Decisions<\/li>\n
  6. Participate in Treatment<\/li>\n
  7. Promote Health<\/li>\n
  8. Get Preventive Health Care<\/li>\n
  9. Plan for the End of Life<\/li>\n
  10. Seek Health Knowledge<\/li>\n<\/ol>\n

    What a great list of “how I’ll know one when I see one!” Tangible, concrete, specific. The full list of 43 could even be a syllabus.<\/p>\n

    But skeptics point out that some patients – some say most patients – don’t want <\/em>to do anything. I can’t count the times I’ve heard docs say patients are lazy or irresponsible – most recently in the new HealthLeaders <\/em>magazine: “In our annual Industry Survey, leaders cite patient noncompliance and lack of responsibility as the fifth-greatest driver of costs.” (We all know couch potatoes, but ugh, what a useless thing for executives to say. They <\/em>act disempowered.)<\/p>\n

    And yet, there are also e-patients: empowered, engaged, educated, enabled – doing what the CFAH describes. How can we move people from spud to spunky?<\/p>\n

    Patient Activation Measure (PAM)<\/strong>
    \n\u00a0This summer I learned about the Patient Activation Measure (PAM). (I heard of it years ago, but didn’t learn <\/em>about it.) The PAM is\u00a0a commercially licensed tool created by Judy Hibbard’s team at the University of Oregon for methodically assessing how activated a patient is – and, importantly, what to do <\/em>with that information, to improve outcomes.<\/p>\n

    ——
    \nAddendum 12\/26\/11: In an email this summer I asked Dr. Hibbard what she’d say if asked to sum up the whole thing. Her reply:<\/em><\/p>\n

    Being patient centered means meeting patients where they are. \u00a0The PAM helps providers understand where a patient is starting from.\u00a0For providers, the PAM is like another “vital sign” telling them essential information they need to effectively work with the patient.
    \n——<\/div>\n<\/blockquote>\n

    Thirteen questions are asked, and patients are scored as level 1, 2, 3 or 4:<\/p>\n

      \n
    1. Does not yet believe they have active\/important role<\/li>\n
    2. Lack confidence and knowledge to take action<\/li>\n
    3. Beginning to take action<\/li>\n
    4. Maintaining behavior over time<\/li>\n<\/ol>\n

      This 45 slide presentation tells more.<\/p>\n